1194155010 NPI number — CORNERSTONE HEALTHCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194155010 NPI number — CORNERSTONE HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194155010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5292 S COLLEGE DR
Provider Second Line Business Mailing Address:
304
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84123-2991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-716-7800
Provider Business Mailing Address Fax Number:
877-676-6599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5292 S COLLEGE DR
Provider Second Line Business Practice Location Address:
304
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84123-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-716-7800
Provider Business Practice Location Address Fax Number:
877-676-6599
Provider Enumeration Date:
11/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
801-913-7913

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1194155010 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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